Healthcare Provider Details

I. General information

NPI: 1538450416
Provider Name (Legal Business Name): BRANDON NEELY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL OKINAWA PSC 482
FPO AP
96362
US

IV. Provider business mailing address

US NAVAL HOSPITAL OKINAWA PSC 482
FPO AP
96362
US

V. Phone/Fax

Practice location:
  • Phone: 011816117437555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: